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Navy and Marine Corps Medical News
MN-00-44
November 3, 2000

     Navy and Marine Corps Medical News (MEDNEWS) is a weekly 
compendium of news and information contributed by commands 
throughout the Navy medical department. Information contained in 
MEDNEWS stories is not necessarily endorsed by Navy Bureau of 
Medicine and Surgery (BUMED), nor should it be considered 
official Navy policy.
     BUMED distributes MEDNEWS to Sailors and Marines, their 
families, civilian employees and retired Navy and Marine Corps 
families. Further distribution is highly encouraged.
     Stories in MEDNEWS use these abbreviations after a Navy 
medical professional's name to show affiliation: MC - Medical 
Corps (physician); DC - Dental Corps; NC - Nurse Corps; MSC - 
Medical Service Corps (clinicians, researchers and 
administrative managers). Hospital Corpsmen (HM) and Dental 
Technician (DT) designators are placed in front of their names.

Contents for this week's MEDNEWS:
- Authorization Act expands TRICARE Health benefits
- Secretary of the Navy Honors Two Navy Doctors
- NH Okinawa awarded three-year JCHAO accreditation
- NH Naples sends 12 to Senegal
- NH Bremerton emergency department named best in state
- Marines Corps promotes environmental health survey 
participation
- TRICARE question and answer
- Healthwatch: Put the brakes on back pain

Stories

Headline: Authorization Act expands TRICARE Health benefits
From the Department of Defense Public Affairs
     Medicare-eligible uniformed services retirees, their 
spouses and survivors who are age 65 and over will be entitled 
to expanded health care benefits under legislation signed by 
President Clinton Oct. 30.
     According to Pentagon data, this population represents 
approximately 1.4 million people. The new benefits include 
coverage under TRICARE, the military's health care program, and 
pharmacy coverage.
     April 1, 2001, is the start date for eligible beneficiaries 
to receive pharmacy benefits including access to military 
treatment facility pharmacies, the National Mail Order Pharmacy 
program and retail pharmacies.
     Beneficiaries who currently are age 65 or older or who will 
be 65 before April 1, 2001, will be eligible to use the pharmacy 
benefit without being enrolled in Medicare Part B. Those who 
turn 65 on or after April 1, 2001, will need to be enrolled in 
Medicare Part B in order to use the pharmacy benefit.
     Effective October 1, 2001, under the new law, eligible 
beneficiaries who continue to receive medical care from their 
current Medicare providers will have TRICARE as their second 
payer. TRICARE will pay their out-of-pocket costs for services 
covered under Medicare.  In addition, they will have access to 
TRICARE benefits that may not be covered under Medicare.  To 
participate in the health program, beneficiaries must be 
eligible for Medicare Part A and enrolled in Medicare Part B.
     "We are pleased to have the legislative authority to 
provide our Medicare-eligible beneficiaries health care benefits 
similar to those other military beneficiaries receive.  We have 
begun to work out the many details for each new authority and 
will continue to update our web site as we progress at 
www.tricare.osd.mil/ndaa/fast_facts.htm. This new authority 
gives us the ability to keep the faith with America's military," 
said Acting Assistant Secretary of Defense for Health Affairs J. 
Jarrett Clinton.
    According to TRICARE Management Activity officials, who will 
administer the new benefit, eligible seniors should NOT 
immediately cancel their current "Medigap" insurance coverage. 
The Department of Defense is working with the Health Care 
Financing Administration (the organization that administers the 
Medicare benefit) to provide the most accurate information on 
the appropriateness of continued enrollment in "Medigap" 
insurance policies.
     According to TRICARE Management Activity officials, 
eligible beneficiaries should do two things now to ensure their 
future eligibility for TRICARE benefits.
     First, they should update their Defense Enrollment 
Eligibility Reporting System (DEERS) record with their correct 
address and any changes in family status such as marriage, 
divorce, birth or adoption.  Home addresses are important 
because the address on file with DEERS is used to send out 
information on health benefits.  In addition, health benefits 
could be denied if DEERS is not updated to reflect a new spouse 
or child.  Retirees may update DEERS by:
-  Going to the nearest military personnel office;
-  E-mailing changes to addrinfo@osd.pentagon.mil
-  Mailing changes to the DEERS Support Office, ATTN: COA, 400
   Gigling Road, Seaside, CA 93955-6771;
-  Calling the toll-free numbers for the DEERS Support Office, 
1-
   800-334-4162 (California only), 1-800-527-5602 (Alaska and 
   Hawaii), and 1-800-538-9552 for the rest of the United 
States.
     Second, eligible beneficiaries should enroll in Medicare 
Part B if they haven't already. If they are not sure if they are 
enrolled, they can check the back of their Social Security card 
for this information.  To enroll, beneficiaries must submit an 
application for Medicare Part B directly to the Social Security 
Administration. The General Enrollment Period for enrollment in 
Medicare Part B is held January 1 through March 31 of each year, 
and Part B coverage starts on July 1 of that year. For details 
on enrollment in Part B, beneficiaries may call the SSA toll-
free number, 800-772-1213, or visit any Social Security office. 
They also can find information on the Medicare Web site, 
medicare.gov.
                             -USN-

Headline: Secretary of the Navy honors two Navy doctors
By Doris Ryan, Bureau of Medicine and Surgery
     Secretary Richard Danzig awarded Legions of Merit to two 
Navy Captains for their work in biomedical research during a 
ceremony 26 Oct 2000, at the Naval Medical Research Center 
(NMRC), Silver Spring, MD.
     "It is wonderful to take time to celebrate two military 
scientists who serve the Navy and humanity and whose 
accomplishments are in the great tradition of Navy medicine," 
said Danzig.
     Capt. David Harlan, MC, was recognized for his research 
into new strategies for the treatment of combat injuries. While 
in the Navy, Harlan developed a new therapy to "educate" the 
immune system to accept a transplanted organ.
     This therapy, called anergy therapy, offers a multitude of 
possibilities for the treatment of combat causalities. Besides 
the implications for military medicine, anergy therapy has the 
potential of treating a broad spectrum of medical conditions 
such as rheumatoid arthritis, insulin dependent diabetes and 
systemic lupus erythematosus.
     It may also have implications for immune reactions such as 
poison ivy and hay fever.
     Harlan, now a member of the Public Health Service, 
continues his transplantation research and clinical studies at 
the National Institutes of Health, Transplantation and 
Autoimmunity Research branch, a joint Navy and National 
Institute of Diabetes and Digestive and Kidney Diseases venture.
     Capt. Stephen Hoffman MC, USNR, was recognized for his 
pioneering work in malaria vaccine development. Hoffman, Head of 
the Malaria Department at NMRC, began his work on DNA-based 
vaccine research in 1992, and in 1998 published the first report 
that DNA vaccines were safe, well tolerated, and elicited an 
immune response in normal, healthy people.
     Four years ago he began studies to sequence the genome of 
Plasmodium falciparum, the parasite responsible for 99 percent 
of the world's deaths due to malaria, and the major cause of 
casualties in DoD operational forces.
     In 1998 his team completed the genomic sequence of 
chromosome 2. This work provides the foundation for completing 
the entire genome in the next few years. His work could lead to 
the development of other DNA-based vaccines used to battle a 
host of infectious diseases such as dengue, tuberculosis, and 
biological warfare threats. 
     "CAPT Harlan's and CAPT Hoffman's research programs and the 
products that they ultimately develop will enhance force health 
protection," said Capt. Richard Hibbs, MC, Commanding Officer of 
NMRC.
     "I believe their continued success and their future 
accomplishments will have significant impact on the practice of 
medicine as we know it and ultimately a significant impact of 
world health."
                             -USN-

Headline: NH Okinawa awarded three-year JCHAO accreditation
By HM1 Brian J. Davis, US Naval Hospital Okinawa
     OKINAWA, Japan - Military healthcare beneficiaries in 
Okinawa and throughout the Western Pacific will be pleased to 
know that U.S. Naval Hospital Okinawa recently received a full 
three-year accreditation from the Joint Commission on 
Accreditation.
     The prestigious accreditation came after a rigorous 
weeklong assessment of the hospital and its nine branch medical 
clinics by a team of inspectors from the Illinois-based 
organization. Evaluators reviewed every aspect of the hospital's 
operation including procedural guidelines, patient education, 
documentation, provider credentials, and sanitation. 
     Naval Hospital Okinawa achieved an extraordinary overall 
score of 90 percent on the evaluation. According to Captain J. 
Dixon, head of USNH Performance Improvement Department, the 
majority of U.S. hospitals receiving JCAHO accreditation score 
in the low to mid 80's. The highest sub-score was given to the 
hospital's Educational and Developmental Intervention Services 
(EDIS), which received a perfect score of 100 percent for the 
facility's first evaluation since its inception.
     "[JCAHO evaluators] judged us by the same yardstick as U.S. 
civilian facilities," said Capt. Dixon. "We met and exceeded 
those standards," he added.
     The accreditation survey was the crowning achievement of a 
series of inspections undergone by the hospital in recent weeks. 
The College of American Pathologists (CAP) inspected laboratory 
facilities in the hospital and branch clinics, awarding the 
facility internationally recognized accreditation. The hospital 
also received a Gold Star rating from Navy Environmental Health 
Center for Command Excellence in Health Promotion.
     In conjunction with the JCAHO evaluation, the Naval Medical 
Inspector General and the Office of Medical Occupational Safety 
and Health inspected the facility. Both inspections resulted in 
reports of "no adverse findings" for the main hospital as well 
as its branch clinics.
     Hospital officials lauded the entire staff for excelling in 
a series of detailed, rigorous inspections. "It really bodes 
well for all of the people that work here," said Capt. Dixon. 
Captain M. H. Mittelman, commanding officer of U.S. Naval 
Hospital Okinawa, summed up the implications of the evaluations 
in an address to staff members. "It is clear that we have set 
the standard for military medicine worldwide," he said.
                             -USN-

Headline: NH Naples sends 12 to Senegal
By LT Steve Brown, NH Naples Public Affairs
     A detachment of U.S. Naval Hospital Naples personnel was 
sent to Senegal to participate in the African Crisis Response 
Initiative (ACRI).  The 12 members provided medical support for 
all U.S. troops, including Army, Navy, Air Force, and Marines, 
who were involved in the ACRI mission.  
     In addition to providing medical support for U.S. troops, 
the Senegalese also benefited from the detachment there. Upon 
leaving Naples, the medical team took with them nearly $150,000 
worth of medical supplies, immunizations, and eyeglass supplies. 
These supplies were used to treat casualties, inprocess 
Senagalese soldiers, and assist the local population with 
medical needs.
     Another aspect of the evolution was functional medical 
training of the Senagalese. U.S. Navy medical personnel held 
training designed to provide knowledge and skills necessary to 
plan and execute medical responsibilities in multiple 
operational environments.
     Members went away from Africa tired, but satisfied. LCDR 
Heilman, the group's OIC, said "Every member of the team has 
made the Navy proud. I could not be more proud of the work they 
have done, without exception."
                             -USN-

Headline: Bremerton emergency department named best in state
By JO2 Michael Howlett, Naval Hospital Bremerton 
     The Washington Emergency Nurse's Association recognized the 
emergency department at Naval Hospital Bremerton as the best in 
the State of Washington during a recent conference in Spokane, 
Wa.
     The department was chosen above all others for having the 
best customer service, most certifications, and for its 
involvement in state and national nurse associations.
     Cmdr. Dennis Jepsen, NC, USN, received the award for the 
hospital. Jepsen heads the nurses in the award-winning 
department.
     The award carries a special significance for the naval 
hospital given the complete turnover of the department in Oct. 
1998. At that time, the Navy returned the emergency room to the 
sailors. Prior to that, an independent contractor had run the 
emergency room.
     This project was an initiative of CAPT Gregg Parker, MC, 
who was the commanding officer of the hospital at that time. It 
was his leadership that led to the turn-around in hospital 
practice and subsequent awards received during his tenure.
     "Without the spirited 'can-do' attitude of the crew, 
departmental improvements could not have taken place nor been as 
successful," said Jepsen of the change to the military staffing. 
"The crew of nurses, physicians, corpsmen, and civilian staff 
pulled together for 24 months, despite extremely demanding 
duties and many exhaustive efforts, to create an outstanding 
Emergency Department."
     In 1999, the hospital received the Customer Satisfaction 
Award for providing the best service of all naval hospitals. The 
quality of care provided in the emergency department helped 
secure the award for the hospital. The staff of the ER is often 
highlighted for recognition by their patients' comments on 
feedback forms.
     "We're really lucky here because everyone loves their 
jobs," said Hospital Corpsman 3rd Class Amber Dahlberg. "Because 
we like what we're doing, the patients see it in the form of 
better customer service."
                             -USN-

Headline: Marines promote environmental health survey 
participation
From Office of the Secretary of Defense
     The Department of Defense announced Wednesday that Marine 
Corps officials are trying to reach about 10,000 former 
residents of on-base housing at Camp Lejeune, N.C., who may have 
been exposed to contaminants in the water supply prior to 1985.
     The effort is being made in support of the Agency for Toxic 
Substances and Disease Registry (ATSDR), a public health service 
agency.
     ATSDR is attempting to survey previous on-base housing 
residents to determine if exposure to drinking water may be 
related to specific health concerns in children who were 
conceived during the time of exposure.
     The survey, which began in September 1999, is seeking 
parents of those children born or conceived while living at base 
family housing at Camp Lejeune between 1968 and 1985.
     "The health and welfare of Marines and their families is 
very important to us," said Colonel Mike Lehnert, head of the 
Marine Corps' Facilities and Services Division. "We have Marine 
families with questions that cannot be answered unless the 
survey is completed, so it is very important to us that we do 
everything possible to help ATSDR reach as many of the former 
residents as they can."
     Lehnert added that it is important for all individuals who 
qualify for the survey to participate, whether or not their 
children have experienced any health concerns.
     Depending on the results of the survey, the ATSDR may 
conduct a health study to enhance scientific understanding of 
the health risks associated with exposure to volatile organic 
compounds (VOCs) in the water supply.
     It is now known that VOCs were present in some base water 
distribution systems that provided water to on-base housing.
     The survey focuses on two specific VOCs, 
tetrachloroethylene (PCE), also called perchloroethylene, and 
trichloroethylene (TCE), often used in dry cleaning or as 
degreasers. Those substances were found in parts of the Camp 
Lejeune water system that supplied the on-base housing areas 
prior to 1985.
     All of the wells containing VOCs were shut down by early 
1985. Currently, all drinking water at Camp Lejeune is regularly 
tested and is safe to drink.
     For the past year, ATSDR and Camp Lejeune officials have 
been trying to contact the former residents using a combination 
of methods including direct mail, news releases around military 
bases, notices in military publications, and open houses.
     To date, more than 6,500 former residents have been 
contacted. However, a significant number of former residents 
have not yet been located.
     In an effort to extend the search for potential survey 
participants, Marine Corps officials in Washington are asking 
national news organizations to assist them in locating these 
former Camp Lejeune residents and their families.
     The 35-question health survey is conducted by telephone and 
attempts to gather data which may be used in a follow-up 
scientific research study about the effects that these 
substances may have on children when exposed before birth.
     All families whose children were born or conceived while 
the family was living at Camp Lejeune from 1968 through 1985 are 
encouraged to participate in this survey, whether or not the 
child has exhibited any health concerns.  To participate, call 
the National Opinion Research Center (NORC) at (800) 639-4270.  
NORC is conducting the survey for the ATSDR.
For more information about the ongoing study, call the ATSDR at 
(888) 42-ATSDR, extension 5132.
                             -USN-

Headline: TRICARE question and answer
     Question: I have an eligible family member with special 
needs. How does TRICARE fit in with the Program for Persons with 
Disabilities (PFPWD), previously known as the Program for the 
Handicapped? 
     Answers: The PFPWD is a financial assistance program for 
active duty dependents with severe physical disabilities or with 
moderate to severe mental retardation who cannot get specialized 
training or care through public resources. 
     Active duty family members can take advantage of both 
TRICARE and the PFPWD programs concurrently. The exception is 
that authorized services provided in conjunction with the PFPWD 
qualifying condition cannot be furnished under the basic program 
as long as the qualifying condition exists and there is a PFPWD 
benefit authorization outstanding. 
     The PFPWD is used concurrently with TRICARE Prime, Extra or 
Standard. Authorization for benefits under PFPWD does not affect 
your enrollment in TRICARE Prime. It does provide an additional 
financial option to explore when utilizing medical resources. 
When you are enrolled in TRICARE Prime, you are assigned a 
Primary Care Manager who has the responsibility to authorize 
specialty care under the Prime program. Benefits not normally 
covered may be cost shared under the PFPWD. 
     Because of the cost associated with care for family members 
with special needs, most families will be encouraged to review 
all of the TRICARE options. Recognizing that the catastrophic 
cap under Extra and Standard is only $1,000, and all further 
cost are covered at 100% by the government, TRICARE Prime may 
not be your best option.
     Further, most State and Federal Agencies cover some of 
these specialty services at little or no additional cost. Check 
with your regional TRICARE Service Center to see which TRICARE 
option is the best for your particular family member.
     For personnel who are Medicare eligible due to a disability 
and are under the age of 65, they still retain their TRICARE 
eligibility.
                             -USN-

Headline: Healthwatch: Put the brakes on back pain
From Bureau of Medicine and Surgery
     About 80 percent of all Americans will experience back 
problems some time in their lives. Nearly 30 percent of those 
people will develop back problems severe enough to keep them 
from work. But taking a few precautions can prevent many of 
these problems. 
     Here are some tips to keep you on your feet and pain free:
- Do exercises that strengthen your back, leg, and abdominal 
muscles, such as walking, running, progressive resistance 
exercises, and weightlifting.
- Sit in straight-backed chairs with firm back support.
- Wear low-heeled shoes. 
- When lifting, squat close to the object, keep it close to your 
body, and lift it slowly, letting your legs do the work, not 
your back.
- Stretch back and leg muscles before and after exercising.
- Sleep on a firm, flat mattress.
- Switch sitting positions frequently.
- When you are standing still, place feet shoulder-width apart 
and periodically shift your weight from one foot to the other.
- Move objects slowly and smoothly.
- When working on a computer, use a document holder to angle 
your work and place your computer screen so you can look 
straight ahead rather than down.
- Keep your weight under control. Extra pounds put a strain on 
your body, including your back.
- Sleep on your side with your legs bent, a small pillow or pad 
between your knees, and your hands near your side.
- On long driving trips, pull over regularly for short 
refreshing walks and stretches. When leaning forward, try to 
lean from the hips rather than the waist, keeping neck and back 
as straight as possible.
- Take a few minutes to walk around the office or do some gentle 
stretches to relieve muscles tension.
- Use shopping bags with handles instead of balancing bags on 
your hips.
- Place your television at, or slightly above, eye level.
- If you experience back pain when lifting, twisting or other 
movements -Stop!
                             -USN- 
Comments and ideas for MEDNEWS are welcome. Story Submissions 
are highly encouraged. Contact MEDNEWS editor, At email: 
mednews@us.med.navy.mil; telephone 202-762-3218, (dsn) 762, or 
fax 202-762-3224.